安非他酮治疗首发抑郁症的疗效和安全性随机对照研究

目的:评价安非他酮时首发抑郁症患者的近期临床疗效及安全性.方法:对125例首发重性抑郁症患者,随机分成安非他酮治疗组和帕罗西汀治疗组,于治疗前,治疗第1、2、4、6周末分别用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、副反应量表(TESS)进行疗效和不良反应评估.结果:安非他酮能迅速减轻抑郁症状,在减轻焦虑症状方面略弱于帕罗西汀,不良反应少于帕罗西汀.结论:安非他酮对首发抑郁症治疗安全有效,不良反应对患者生存质量影响方面小于帕罗西汀.     

帕罗西汀对终末期肾病透析患者的焦虑抑郁障碍的治疗研究

目的评价帕罗西汀治疗终末期肾病（ERSD）患者的焦虑与抑郁症状的疗效。方法对74名伴发抑郁焦虑障碍终末期肾病患者，进行为期4周的随机对照研究，实验组、对照组各37例，以汉密顿焦虑量表（HAMA）和汉密顿抑郁量表（HAMD）评定疗效。结果帕罗西汀组焦虑与抑郁症状的减轻明显优于对照组（P〈0．05—0．01）。结论帕罗西汀能有效减轻终末期肾病患者的焦虑、抑郁症状，且不良反应小，提高对透析治疗的依从性。     

帕罗西汀治疗恶性血液病伴发抑郁症,焦虑症——附39例资料分析

目的：评价帕罗西汀治疗恶性血液病伴发抑郁、焦虑症的临床疗效,方法：３９例病人应用帕罗西汀,２０ｍｇ／ｄ晨服１次,共６周。治疗前后采用汉密尔顿抑郁量表（ＨＡＭＤ）,焦虑量表（ＨＡＭＡ）,抑郁自我评定量表（ＳＤＳ）,焦虑自评表（ＳＡＳ）进行分析。结果：帕罗西汀对抑郁症总有效率为９０％;焦虑症为９５％。未发生严重不良反应。结论：帕罗西汀能减轻恶性血液病伴发的抑郁、焦虑症状,提高病人生存质量。     

帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍对照研究

目的：探讨帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍患者的疗效和安全性。方法将60例广泛性焦虑障碍患者按随机数字表法分为两组,每组30例,均晨口服帕罗西汀治疗,研究组联合认知行为治疗,观察8周。治疗前后采用汉密顿焦虑量表、汉密顿抑郁量表、症状自评量表评定疗效,副反应量表评定不良反应。结果两组汉密顿焦虑量表、汉密顿抑郁量表总分及症状自评量表躯体化、人际关系、抑郁、焦虑因子分均较治疗前显著下降（P＜0．01）,研究组评分显著低于对照组（ P＜0．05或0．01）;研究组总有效率为93．3％,对照组63．3％,研究组显著高于对照组（P＜0．01）。治疗后两组副反应量表评分及各项不良反应发生率比较差异均无显著性（P＞0．05）。结论帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍患者具有协同增效作用,起效快,疗效显著,安全性高。     

帕罗西汀联合瑜伽放松训练对抑郁症患者负性情绪的影响

目的探讨帕罗西汀联合瑜伽放松训练对抑郁症患者负性情绪的影响。方法将60例抑郁症患者随机分为两组,每组30例,两组均口服帕罗西汀治疗,并予以精神科常规护理,研究组在此基础上联合瑜伽放松训练,观察8周。于治疗前及治疗4周、8周末采用焦虑自评量表和抑郁自评量表评定两组焦虑抑郁情绪状况。结果研究组治疗4周末起焦虑自评量表、抑郁自评量表评分均较治疗前显著下降（P〈0．01）,对照组治疗8周末焦虑自评量表、抑郁自评量表评分均较治疗前显著下降（P〈0．05或0．01）;治疗前两组焦虑自评量表、抑郁自评量表评分比较差异均无显著性（P〉0．05）,治疗4周末起,研究组焦虑自评量表评分较对照组下降更显著（P〈0．01）,治疗8周末,研究组抑郁自评量表评分较对照组下降更显著（P〈0．01）。结论帕罗西汀联合瑜伽放松训练能有效改善抑郁症患者的负性情绪,显著优于单用帕罗西汀治疗。     

帕罗西汀联合米氮平治疗难治性抑郁症对照研究

目的：探讨帕罗西汀联合米氮平治疗难治性抑郁症的疗效和安全性。方法将56例难治性抑郁症患者分为两组,均口服帕罗西汀治疗,研究组在此基础上联合米氮平治疗,观察8周。于治疗前后采用汉密顿抑郁量表、汉密顿焦虑量表、副反应量表评定疗效和不良反应。结果治疗8周末研究组显效率为67．9％、总有效率为92．9％,对照组分别为25．0％、78．6％,研究组显效率显著高于对照组（ P＜0．01）。研究组不良反应发生率为35．7％,对照组为32．1％,两组比较差异无显著性（P＞0．05）。结论帕罗西汀联合米氮平治疗难治性抑郁症起效快,疗效显著,安全性高,优于单用帕罗西汀治疗。     

帕罗西汀联合奥氮平治疗对抑郁症抑郁程度及睡眠质量的影响

目的:探讨帕罗西汀联合奥氮平治疗对抑郁症患者抑郁程度及睡眠质量的影响。方法:选取2018年1月至12月期间淄博市精神卫生中心收治的抑郁症患者86例作为研究对象,利用随机数字表随机分为观察组与对照组,每组43例。对照组给予帕罗西汀治疗,观察组给予帕罗西汀联合奥氮平治疗。治疗12周后,比较2组患者抑郁程度及睡眠情况。结果:观察组HAMD评分(13. 43±2. 86)分,明显低于对照组(P 0. 05);入睡时间(14. 86±1. 25) min、睡眠时长(6. 73±1. 35) h、深睡眠时间(4. 36±0. 78) h,与对照组比较差异有统计学意义(P 0. 05)。结论:帕罗西汀联合奥氮平治疗可有效改善抑郁症患者的抑郁程度及睡眠质量。     

帕罗西汀联合心理干预治疗卒中后的心理护理

目的 探讨帕罗西汀联合早期心理干预对卒中后抑郁/焦虑患者日常生活能力和神经功能康复的影响.方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对272例脑卒中患者进行抑郁/焦虑状态评定,其中患有卒中后抑郁合并焦虑的81名患者分别接受单用帕罗西汀治疗、帕罗西汀合并心理治疗以及不干预.采用斯堪的那维亚脑卒中量表(SSS)、Barthel指数(BI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评测治疗前后的疗效.结果 急性脑卒中病人卒中后抑郁并焦虑患病率为29.78％,抑郁与焦虑共病率为65.85％;治疗组Ⅰ和治疗组ⅡHAMD、HAMA、SSS评分减少和BI评分增加与对照组比较均有显著性差异(P均＜0.01),治疗组ⅡHAMD、HAMA、SSS评分减少和BI评分增加较治疗组Ⅰ有显著差异(P均＜0.05).结论 卒中后抑郁/焦虑病人单用药物帕罗西汀或给予帕罗西汀合并心理干预治疗均能提高患者神经功能康复程度和生活能力恢复,而且帕罗西汀合并心理干预治疗疗效更满意.     

帕罗西汀联合奥氮平治疗难治性抑郁症对照研究

目的：探讨帕罗西汀联合奥氮平治疗难治性抑郁症的临床疗效和安全性。方法将78例难治性抑郁症患者随机分为两组,每组39例,均口服帕罗西汀治疗,在此基础上研究组联合奥氮平治疗,观察8周。采用汉密顿抑郁量表、汉密顿焦虑量表评定临床疗效,副反应量表评定不良反应。结果治疗2周末起两组汉密顿抑郁量表、汉密顿焦虑量表总分均较治疗前显著性下降（P＜0．01）,研究组治疗各时段评分均显著低于对照组（P＜0．01）;治疗8周末研究组有效率为87．2％,对照组为66．7％,研究组显著高于对照组（χ2＝4．62,P＜0．05）。研究组不良反应发生率为43．6％,对照组为46．2％,两组比较差异无显著性（χ2＝0．05,P＞0．05）。结论帕罗西汀联合奥氮平治疗难治性抑郁症起效快,疗效显著,安全性高,依从性好,优于单用帕罗西汀治疗。     

帕罗西汀联合奥氮平对抑郁症患者的疗效

目的:探讨帕罗西汀联合奥氮平治疗抑郁症患者的疗效。方法:抑郁症患者100例,随机分为观察组和对照组各50例。2组均给予帕罗西汀,观察组联合奥氮平进行治疗。治疗后比较2组在HAMD量表和抑郁症事件相关电位P300的情况。结果:治疗后,对照组HAMD评分为(14.5±3.5)分,减分率为49.65%;观察组HAMD评分降至(10.5±3.1)分,减分率达63.16%;2组比较差异有统计学意义(P<0.05)。治疗后,2组ERP波形的P300潜伏期都有所缩短,但观察组比对照组更明显,差异有统计学意义(P<0.05);2组的波幅在治疗后差异有统计学意义(P<0.05)。结论:针对抑郁症患者,采取帕罗西汀联合奥氮平治疗能有效缓解抑郁症状。     

Patterns of depressive symptoms in three groups of depressed adults

This study examined patterns of depressive symptoms experienced by acutely depressed inpatients, previously hospitalized depressed outpatients, and depressed outpatients who had never been hospitalized for depression. The groups' symptom profiles were compared to determine whether the 21 major depressive symptoms measured by the Beck Depression Inventory were similar or different for the three groups. The groups differed significantly on five depressive symptoms that are classified as affective/cognitive symptoms (sadness, guilt, self-blame, indecisiveness, suicidal ideas) and one that is considered a somatic/vegetative symptom of depression (anorexia). Thus, commonly used diagnostic criteria may not reflect the full range or temporal patterning of symptoms experienced by depressed persons at varying levels of acuity or severity and in different treatment settings.     

PATTERNS OF DEPRESSIVE SYMPTOMS IN THREE GROUPS OF DEPRESSED ADULTS

This study examined patterns of depressive symptoms experienced by acutely depressed inpatients, previously hospitalized depressed outpatients, and depressed outpatients who had never been hospitalized for depression. The groups' symptom profiles were compared to determine whether the 21 major depressive symptoms measured by the Beck Depression Inventory were similar or different for the three groups. The groups differed significantly on five depressive symptoms that are classified as affective/ cognitive symptoms (sadness, guilt, self-blame, indecisiveness, suicidal ideas) and one that is considered a somatic/vegetative symptom of depression (anorexia). Thus, commonly used diagnostic criteria may not reflect the full range or temporal patterning of symptoms experienced by depressed persons at varying levels of acuity or severity and in different treatment settings.     

The impact of migraine on patients with major depressive disorder

BACKGROUND: The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described. OBJECTIVE: To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression. METHODS: This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated. RESULTS: Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode. CONCLUSIONS: Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.     

Efficacy and tolerability of mirtazapine in treating major depressive disorder with anxiety symptoms: an 8-week open-label randomised paroxetine-controlled trial

Aims: Prominent anxiety symptoms are related to poor clinical course and outcome in major depressive disorder (MDD). The aim of this randomised, open‐label, controlled study is to compare the efficacy and tolerability of mirtazapine in the form of orally disintegrating tablets against paroxetine in treating MDD patients with anxiety symptoms. Methods: A total of 60 MDD patients with a score above 18 on the Hamilton Anxiety Rating Scale (HARS) were randomly assigned to 8 weeks of fixed dosing treatment with mirtazapine (15–30 mg/day) and paroxetine (10–20 mg/day). Efficacy was primarily assessed with the HARS and with the 17‐item Hamilton Depression Rating Scale (HDRS) at weeks 1, 2, 4 and 8 after treatment. Tolerability was assessed from adverse events. Results: The generalised estimating equations (GEE) models showed that the rates of improvement in HDRS scores from baseline to week 8 were similar between mirtazapine and paroxetine groups. However, patients with mirtazapine exhibited earlier improvement in HARS scores at weeks 1 and 2. Week‐by‐week GEE models showed that these significant differences in improvement of HARS scores between the two treatment groups were detectable from the first evaluation after the treatment (week 1) and maintained through week 2. There was no difference in the overall frequency of adverse events experienced between the two treatment groups. The most common adverse event in the mirtazapine group was somnolence (n = 8), whereas that in the paroxetine group was gastrointestinal discomfort (n = 9). Conclusions: Mirtazapine and paroxetine were equally effective and well tolerated for the depressive symptoms in MDD patients with the high level of anxiety symptoms. Mirtazapine was, however, more effective in reducing the anxiety symptoms than paroxetine in the early weeks of treatment, suggesting that mirtazapine may have an earlier‐onset action for the anxiety symptoms in MDD patients.     

Increased health burden associated with comorbid depression in older diabetic Mexican Americans. Results from the Hispanic Established Population for the Epidemiologic Study of the Elderly survey.

OBJECTIVE: To examine the health burden associated with concomitant depressive symptoms and diabetes in older Mexican Americans. RESEARCH DESIGN AND METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used to assess the association between high levels of depressive symptoms, measured with the Center for Epidemiologic Studies of Depression scale, and comorbid chronic health conditions, diabetic complications, functional disability, health service use, and medication use among 636 older diabetic Mexican Americans, in comparison with 2,196 older nondiabetic Mexican Americans. RESULTS: Overall, 31.1% of the older diabetic individuals reported high levels of depressive symptoms. The risks of comorbid myocardial infarction, hypertension, arthritis, and angina were significantly higher in the presence of concomitant depressive symptoms, as were the risks of diabetic complications, functional disability, incontinence, vision impairment, poorer perceived health status, and health service use among both diabetic and nondiabetic individuals. Rates were substantially higher among depressed diabetic individuals, however, in comparison to depressed nondiabetic individuals. Importantly, this increased health burden was evident even when controlling for sociodemographic risk factors, including sex, age, level of education, marital status, immigrant status, and living arrangements. CONCLUSIONS: The presence of concomitant depressive symptoms among older diabetic Mexican Americans is associated with a substantially greater health burden than is seen among diabetic individuals without depression or depressed individuals without diabetes. This association of depression with higher rates of chronic conditions, poorer functioning, and increased health service use is particularly significant in that this study was conducted among community-dwelling adults and was not confounded by the potential association of health care-seeking behavior that might occur in a medically ill sample.     

Efficacy and tolerability of controlled-release paroxetine in the treatment of severe depression: post hoc analysis of pooled data from a subset of subjects in four double-blind clinical trials

OBJECTIVES: The aims of this work were to assess the efficacy and tolerability of controlled-release paroxetine (paroxetine CR) in the treatment of outpatients with severe major depressive disorder (MDD). METHODS: This was a retrospective analysis of pooled data from 4 previously published, double-blind, randomized, placebo-controlled, 8- to 12-week outpatient studies of paroxetine CR (12.5-62.5 mg) in MDD. However, the studies were designed to assess the efficacy of paroxetine CR overall, rather than specifically in those with severe MDD. Subjects were categorized according to their baseline mean 17-item Hamilton Depression Rating Scale (HAMD-17) total score as having severe (> or =25) or nonsevere (<25) depression. Changes in depressive symptomatology were assessed, based on the mean change from baseline in HAMD-17 total scores and the proportion of responders (> or =50% reduction from baseline in HAMD-17 total scores or Clinical Global Impression [CGI] of Improvement scores of 1 or 2), for each study and pooled across the studies. The pooled analysis of data also assessed the proportion of patients achieving remission (HAMD-17 total score < or =7 or CGI-Improvement score of 1) at last-observation-carried-forward end point. RESULTS: A total of 1083 subjects participated in the 4 studies; 303 had severe MDD (paroxetine CR, n = 174; placebo, n = 129). Among the patients with severe MDD, most were women, had a mean HAMD-17 score between 26.3 and 27.7, and had a mean CGI of Severity score between 4.5 and 4.9. In 3 studies, the mean age of such participants was between 35 and 43 years. However, the fourth study was an evaluation in late-life depression in which the mean age was 71.3 years in the paroxetine CR group and 70.0 years in the placebo group. In the overall pooled sample, significantly greater improvements in depressive symptoms were observed among those with severe MDD who were treated with paroxetine CR compared with those who received placebo (HAMD-17 total treatment difference, -4.37 [95% CI, -6.31 to -2.42; P < 0.001]). The odds of CGI-Improvement response were also significantly higher for patients receiving paroxetine CR than those receiving placebo, regardless of baseline depressive symptomatology (severe MDD: odds ratio [OR], 2.42 [95% CI, 1.50-3.91; P < 0.001]; nonsevere MDD: OR, 1.63 [95% CI, 1.21-2.19; P < 0.002] ). Withdrawal rates due to adverse events were 9.8% versus 5.4% (severe) and 5.2% versus 4.5% (nonsevere), paroxetine CR versus placebo, respectively. CONCLUSIONS: This post hoc analysis of pooled data suggests that paroxetine CR was effective and well tolerated in these outpatients with severe MDD.     

120例抑郁症患者的临床分析

目的　比较综合性医院中有无躯体化症状抑郁症患者的临床特征。方法　采用半定式检查方法 ,对连续就诊并且符合CCMD 3 R和ICD 10抑郁症诊断标准的患者采用HAMD、HAMA、SCL 90及自制的躯体调查表进行评定。结果　伴躯体化症状组中HAMD总分以及焦虑 /躯体化阻滞和绝望感因子分、HAMA总分以及精神性焦虑躯体性焦虑因子分、SCL 90中躯体化、人际关系、抑郁焦虑和恐怖因子分均显著高于无躯体化症状组。结论　综合性医院中抑郁症的躯体化症状 ,不仅受抑郁障碍影响 ,同时与焦虑障碍有关。     

艾司西酞普兰与帕罗西汀治疗抑郁症的对照研究

目的观察艾司西酞普兰治疗抑郁症的疗效及安全性。方法将68例抑郁症患者随机分为艾司西酞普兰组和帕罗西汀组,疗程6周,以汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定疗效,以症状用量表（TESS）评定不良反应。结果艾司西酞普兰组和帕罗西汀组有效率分别为94．1％和91．1％,两组疗效差异无显著性意义,但治疗1周后艾司西酞普兰组有效率高于帕罗西汀组。结论艾司西酞普兰是一种安全有效的抗抑郁药。     

Sertraline effectiveness and safety in depressed oncological patients

Goals of work Cancer is often burdened by psychological comorbidity, mainly represented by depression, anxiety and adjustment disorders. Efficacy and tolerability of sertraline in the treatment of depressive disorders is well known; however, its efficacy and safety in patients with cancer has been poorly studied. This study was aimed to provide evidences of effectiveness, safety, tolerability and rapidity of action of sertraline in a population of oncological outpatients affected by mood disorders and its effects on quality of life. Materials and methods Thirty-five adult cancer outpatients with mood depression, during chemotherapy, were enrolled to a 12-week trial with a flexible dose regime of sertraline. The treatment response was assessed at baseline, week 4 and week 12, with hospital anxiety and depression scale (HADS) and Montgomery Asberg depression rating scale (MADRS), to rate depression and anxiety; mini mental adjustment to cancer scale (Mini-MAC), to assess the psychological response to the diagnosis of cancer; clinical global impression (CGI) to evaluate severity of illness; dosage record and treatment emergent symptom scale (DOTES), to assess the adverse effects of the clinical treatments and their possible relation with the drug used; and QL index to rate quality of life. Main results Both mean depression scores, analysed by HADS and MADRS scales, and HADS anxiety scores significantly decreased during the 12 weeks of study. Mean MINI-MAC scores show that hopelessness and anxious preoccupation decreased significantly at T2 compared with T0. No severe adverse effects were observed. Conclusion In this preliminary study, sertraline was found to be effective and well tolerated in the treatment of depressed outpatients with cancer.     

Prevalence and predictors of anxiety and depression among family caregivers of cancer patients: a nationwide survey of patient–family caregiver dyads in Korea

Purpose

This study aimed to identify the prevalence and predictors of anxiety and depression among family caregivers of patients with cancer in Korea.

Methods

A national, multicenter, cross-sectional survey was conducted with 897 family caregivers. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression in patient–family caregiver dyads.

Results

The prevalence of anxiety in family caregivers was 38.1 %:20.3 % reported mild anxiety, 13.3 % reported moderate anxiety, and 4.6 % reported severe anxiety. The prevalence of depression was 82.2 %:40.4 % reported mild depression, 25.5 % reported moderate depression, and 16.3 % reported severe depression. Family caregivers who were younger, were caring for male patients, or had a low quality of life (QOL) in relation to three of the variables measured in the Korean Caregiver Quality of Life Index-Cancer (CQOLC-K): burden, disturbance, and financial concerns reported increased anxiety. Becoming unemployed during caregiving, being the spouse of a patient and having low QOL in relation to three of the variables measured by the CQOLC-K: burden, disturbance, and positive adaptation were associated with depression among family caregivers. The predictive validity of the selected variables were 0.861 (95 % CI: 0.844–0.892) for anxiety and 0.794 (95 % CI: 0.751–0.828) for depression.

Conclusions

Family caregivers of patients with cancer experienced high levels of anxiety and depression. Socio-demographic factors and QOL were predictors of anxiety and depression in family caregivers.